Provider Demographics
NPI:1568822393
Name:GUTIERREZ, MARIA VERONICA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VERONICA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 APPLE ST STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4443
Mailing Address - Country:US
Mailing Address - Phone:760-439-4577
Mailing Address - Fax:
Practice Address - Street 1:1919 APPLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4492
Practice Address - Country:US
Practice Address - Phone:760-439-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health